Adachi Tsubasa, Higuchi Shinji, Okuma Tomohisa, Mori Jun
Division of Pediatric Endocrinology, Metabolism and Nephrology, Children's Medical Center, Osaka City General Hospital, Osaka, JPN.
Department of Diagnostic Radiology, Osaka City General Hospital, Osaka, JPN.
Cureus. 2025 Jan 2;17(1):e76818. doi: 10.7759/cureus.76818. eCollection 2025 Jan.
Children with developmental disorders such as autism spectrum disorder (ASD) may not only develop type 2 diabetes mellitus (T2DM) due to psychosocial stress and overeating but also experience severe complications such as acute pancreatitis (AP) and hypertriglyceridemia (HTG). Consequently, in pediatric patients with concurrent T2DM and developmental disorders, a comprehensive approach is necessary that includes not only imaging evaluations for AP but also assessments of risk factors such as psychological stress and metabolic abnormalities. We report the case of a 13-year-old male child, with a family history of T2DM in his paternal grandfather, who presented with severe diabetic ketoacidosis (DKA) and HTG (triglycerides 2118 mg/dL). His condition was considered to have been triggered by psychosocial stress following the divorce of his parents two months previously, which led to episodes of overeating. Two weeks prior to admission, he had consumed excessive amounts of soft drinks. The patient was initially treated with fluids, insulin, and mannitol for cerebral edema. On the third day post admission, he developed AP, which was confirmed by the occurrence of abdominal pain, elevated pancreatic enzyme levels, and the findings of CT imaging. Subsequent imaging revealed pancreatic divisum. The patient was also diagnosed with ASD during hospitalization. Following a temporary initial recovery, the patient experienced worsening obesity and was started on metformin and icosapent ethyl to manage recurrent T2DM and HTG. In this case, the development of T2DM was considered to have been primarily associated with ASD, which subsequently led to DKA, HTG, and AP, with pancreatic divisum believed to be an additional predisposing factor contributing to these conditions. To the best of our knowledge, there have been no previous reports of T2DM associated with DKA, HTG, AP, ASD, and pancreatic divisum.
患有自闭症谱系障碍（ASD）等发育障碍的儿童，不仅可能因心理社会压力和暴饮暴食而患上2型糖尿病（T2DM），还可能出现急性胰腺炎（AP）和高甘油三酯血症（HTG）等严重并发症。因此，对于同时患有T2DM和发育障碍的儿科患者，需要一种综合方法，不仅包括对AP的影像学评估，还包括对心理压力和代谢异常等危险因素的评估。我们报告一例13岁男童病例，其祖父有T2DM家族史，该患儿出现严重糖尿病酮症酸中毒（DKA）和HTG（甘油三酯2118mg/dL）。其病情被认为是由两个月前父母离婚后的心理社会压力引发的，这导致了暴饮暴食。入院前两周，他饮用了过量的软饮料。患者最初接受了补液、胰岛素和甘露醇治疗脑水肿。入院后第三天，他出现了AP，通过腹痛、胰腺酶水平升高以及CT成像结果得以证实。随后的影像学检查显示胰腺分裂。该患者在住院期间还被诊断出患有ASD。在最初暂时恢复后，患者肥胖情况恶化，开始使用二甲双胍和二十碳五烯酸乙酯来控制复发性T2DM和HTG。在本病例中，可以认为T2DM的发生主要与ASD相关，随后导致了DKA、HTG和AP，胰腺分裂被认为是导致这些情况的另一个易感因素。据我们所知，此前尚无T2DM与DKA、HTG、AP、ASD和胰腺分裂相关的报道。
